Daisuke Kobayashi

Oxaliplatin‐induced peripheral neuropathy (OIPN) causes numbness and pain in the limbs, often leading to interruption of chemotherapy and representing a significant clinical problem. Previous basic studies have suggested that the dipeptidyl peptidase‐4 (DPP‐4) inhibitor alogliptin may prevent OIPN. To evaluate whether concomitant use of DPP‐4 inhibitors could prevent the development of OIPN in clinical practice, we retrospectively analyzed data from 1180 patients who initiated oxaliplatin treatment at Kyushu University Hospital between January 1, 2009 and December 31, 2019. The primary endpoint was the occurrence of OIPN of any grade. Kaplan–Meier analysis with cumulative doses demonstrated a significantly lower incidence of OIPN in the DPP‐4 inhibitor group ( p = 0.0422). After propensity score matching to adjust for patient backgrounds, the protective association remained significant ( p = 0.0389). Furthermore, Cox proportional hazards analysis incorporating gender, age, regimen, and concomitant DPP‐4 inhibitor use as covariates confirmed that DPP‐4 inhibitor use was an independent protective factor for OIPN (HR = 0.690; 95% CI, 0.490–0.972; p = 0.034). These findings suggest that concomitant use of DPP‐4 inhibitors may moderate the development of OIPN in patients receiving oxaliplatin.

Background: Hematologic malignancies, including leukemias and lymphomas, remain life-threatening diseases for which preventive strategies have not yet been established. Recent studies have suggested that sodium-glucose cotransporter 2 (SGLT2) inhibitors have cancer-suppressive properties. This study investigated whether SGLT2 inhibitors are associated with reduced risk of hematologic malignancies in patients with diabetes, using a large-scale medical database. Methods: Data of patients with diabetes prescribed diabetes medications were extracted from the JMDC Payer database (January 2005 to November 2023). After exclusions, patients were categorized into SGLT2 inhibitor (n = 158 877) and non-SGLT2 inhibitor (n = 118 678) groups. Propensity score matching, accounting for patient characteristics, resulted in 102 478 matched patients per group. The primary endpoint was time to hematologic malignancy; secondary endpoints were time to lymphoma, leukemia, and their subcategories. Results: The incidence of hematologic malignancies was lower in the SGLT2 inhibitor group than in the non-SGLT2 inhibitor group (P < .001, hazard ratio [HR] = 0.73, 95% CI = 0.62 to 0.86, risk difference at 5 years (RD) = −0.16%). Lymphoma incidence was also lower in the SGLT2 inhibitor group (P = .003, HR = 0.71, 95% CI = 0.57 to 0.89, RD = −0.12%), whereas no clear evidence of difference was observed for leukemia (P = .06, HR = 0.76, 95% CI = 0.57 to 1.01, RD = −0.02%). Lymphocytic leukemia was associated with lower incidence compared to the non-SGLT2 inhibitor group (P = .04, HR = 0.44, 95% CI = 0.19 to 0.99, RD = −0.02%), whereas no clear evidence of difference was observed for myeloid leukemia (P = .12, HR = 0.76, 95% CI = 0.54 to 1.08, RD = −0.01%). Regarding acute myeloid leukemia (AML), the incidence was low in the SGLT2 inhibitor group (P = .001, HR = 0.34, 95% CI = 0.19 to 0.62, RD = −0.05%). Conclusion: SGLT2 inhibitor use may be associated with lower risk of hematologic malignancies in adults with diabetes.

Malnutrition implies a decline in the systemic status and organ function, which is closely related to sarcopenia, frailty, osteoporosis, and prognosis. Diabetes medications work in a multifaceted manner on various tissues, such as the pancreas, muscle, liver, and adipose tissue; these medications affect metabolism, which in turn affects nutritional status. This study aimed to determine the effect of diabetes medications on the scores of the Geriatric Nutrition Risk Index (GNRI) and Controlling Nutritional Status (CONUT) nutritional indices, both cross‐sectionally and longitudinally. This cross‐sectional study included 2146 individuals who were prescribed diabetes medications. Multivariate analysis showed that both GNRI and CONUT scores tended to be improved in patients using sodium‐glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase 4 inhibitors (DPP4i), or biguanide (BG). Additionally, propensity score matching of nutrition‐related laboratory values was performed to assess the variation in nutritional indices over time, which resulted in less deterioration of the GNRI in the SGLT2i and BG groups. In conclusion, this study suggests that SGLT2i and BG prevent the progression of malnutrition and may help in selecting drugs that consider the nutritional status of patients.

Background: Oxaliplatin‐induced peripheral neuropathy (OIPN) is a major clinical challenge because it leads to discontinuation of chemotherapy. Omeprazole, a proton pump inhibitor (PPI), has been shown to prevent OIPN in a rat model. Therefore, we aimed to test whether the concomitant use of a PPI reduces oxaliplatin discontinuation due to OIPN. Methods: This retrospective study used data from 1015 patients who started treatment with oxaliplatin and evaluated two cohorts (PPI vs. non‐PPI). The primary outcome measure was oxaliplatin discontinuation due to OIPN. A Kaplan–Meier curve was generated for cumulative doses and evaluated using the log‐rank test and Cox proportional hazards analysis. Results: The log‐rank test showed that the number of patients who discontinued oxaliplatin due to OIPN was significantly lower in the PPI group ( p = 0.0264). Cox proportional hazards analysis incorporated and analyzed factors previously reported as potentially affecting neuropathy (sex, age, use of PPIs, calcium channel antagonists, opioids and adjuvant analgesics, and the CAPOX [capecitabine + oxaliplatin] regimen). The analysis suggested that the concomitant use of PPIs was a factor in reducing oxaliplatin discontinuation (adjusted hazard ratio [HR] = 0.568, 95% confidence interval [CI], 0.344–0.937, p = 0.0269). Since there were significant differences in some patient demographics between the two groups, propensity score matching was performed to align the patient demographics and then reanalyzed. After propensity score matching, the same analysis as above showed that oxaliplatin discontinuation due to OIPN was significantly less common in the PPI group ( p = 0.0081); cox proportional hazards analysis showed that PPI use was a factor that significantly reduced oxaliplatin discontinuation due to OIPN (adjusted HR = 0.478, 95% CI, 0.273–0.836, p = 0.0096). Conclusions: These results suggest that concomitant PPI use may reduce oxaliplatin discontinuation due to OIPN in patients receiving oxaliplatin.

Purpose Paclitaxel and albumin-bound paclitaxel are important anticancer drugs for the treatment of non-small cell lung, pancreatic, gastric, and gynecological cancers; however, they cause peripheral neuropathy as an adverse reaction. Therefore, prophylaxis and treatment for peripheral neuropathy are needed, since there are no sufficient evidence-based strategies to prevent it. Our previous animal research and adverse effect database analysis studies have identified the potential of α1 antagonists to attenuate paclitaxel-induced peripheral neuropathy (PIPN). The purpose of the present study was to investigate the prophylactic potential of α1 antagonists for PIPN in patients with cancer. Methods Data were collected from the medical records of 673 male patients aged 18 years and older who started treatment with paclitaxel- or albumin-bound paclitaxel-containing regimens at Kyushu University Hospital between January 1, 2013, and December 31, 2019. The two primary outcome measures were PIPN occurrence and paclitaxel discontinuation due to PIPN. Kaplan–Meier curves were generated for cumulative doses and evaluated using the log-rank test. Results The percentage of patients in whom PIPN occurred (any grade) during the entire study period was 37.4% and 20.0% in without and with α1-receptor antagonist groups, respectively (P = 0.0101, χ² test). The incidence of PIPN (any grade) was significantly lower in the α1 antagonists combination group (N = 55) than in the no α1-receptor antagonists group (N = 618) (P = 0.0425, log-rank test). However, there were no significant differences between the two groups in the discontinuation of paclitaxel due to PIPN (P = 0.9654). Conclusions The present retrospective cohort study may suggest that concomitant use of α1-receptor antagonists may moderate the development of PIPN.

Japan's largest platform for academic e-journals: J-STAGE is a full text database for reviewed academic papers published by Japanese societies

Japan's largest platform for academic e-journals: J-STAGE is a full text database for reviewed academic papers published by Japanese societies

Japan's largest platform for academic e-journals: J-STAGE is a full text database for reviewed academic papers published by Japanese societies

Benzodiazepine receptor agonists (BZDs) should be appropriately used owing to the associated risks of delirium and falls. Since January 2018, the liaison team pharmacist at Iizuka Hospital has been applying digital labels with recommendations for the reduction of use and changes in the medication orders and prescriptions of BZDs on electronic medical records of patients in the surgical ward. This study aimed to verify the effectiveness of reducing the use of BZDs via the implementation of digital labels. Patients in the surgical ward were retrospectively assessed for changes in medication orders and prescription ratios of BZDs before and after the implementation of digital labels. The ratio of the number of digital labels implemented to the number of confirmations of medication orders and prescriptions of BZDs was 15.0% at the start of implementation; however, the ratio gradually and significantly decreased to 3.6%. The medication order ratio of BZDs was 52.2% before the implementation of digital labels; however, this ratio decreased to 2.7% and 5.6% immediately and 4 months after the implementation of digital labels, respectively. The present study showed that medication orders for BZDs were reduced after the implementation of digital labels and that the reduction effect was maintained for a certain period of time. Thus, the liaison team pharmacist-led approach can contribute to the proper use of BZDs.

259 Background: In the past, various prognostic factors in pancreatic ductal carcinoma (PDAC) have been identified, and there found to be not only tumor-specific clinicopathological factors but also individual patient characteristics. In particular, weight loss, muscle wasting and cachexia are hallmarks of PDAC that may be associated with depletion of both skeletal muscle and adipose tissue. Most notably, sarcopenia is defined to be degenerative loss of skeletal muscle mass that is quantifiable using cross sectional imaging computed tomography (CT) by measurement of psoas area and the muscle’s density. Furthermore, visceral adipose tissue loss also has been reported to associate with a poor survival among patients with PDAC. Methods: A total of 265 patients who underwent curative surgery for PDAC were examined in this study. The total skeletal muscle and fat tissue areas were evaluated in a single image obtained at the third lumber vertebra during a preoperative computed tomography (CT) scan. The patients were assigned to either the sarcopenia or non-sarcopenia group based on their skeletal muscle index (SMI) and classified into high visceral fat area (H-VFA) or low VFA (L-VFA) groups. The association of clinicopathological features and prognosis with the body composition were statistically analyzed. Results: There were 170 patients (64.2%) with sarcopenia. The median survival time (MST) was 23.7 months for sarcopenia patients and 25.8 months for patients without sarcopenia. The MST was 24.4 months for H-VFA patients and 25.8 months for L-VFA patients. However, sarcopenia patients with BMI ≥ 22 exhibited significantly poorer survival than patients without sarcopenia (MST: 19.2 vs. 35.4 months, P = 0.025). There was a significant difference between patients with and without sarcopenia who did not receive chemotherapy (5-year survival rate: 0% vs. 68.3%, P = 0.003). The multivariate analysis revealed that tumor size, positive dissected peripancreatic tissue margin, and sarcopenia were independent prognostic factors. Conclusions: Sarcopenia is an independent prognostic factor in PDAC patients with a BMI ≥ 22. Therefore, evaluating skeletal muscle mass may be a simple and useful approach for predicting patient prognosis.